Clinical Experience and Practical Considerations of High-Intensity Focused Ultrasound for Eyelid Sagging

Background: Eyelid sagging is a common sign of aging that impacts both aesthetic appearance and visual function. Non-invasive modalities, including high-intensity focused ultrasound (HIFU) have emerged as promising alternatives to surgical correction. Methods: This prospective observational study evaluated the efficacy and safety of HIFU for upper and lower eyelid sagging. Twenty Korean women aged 35–57 years with mild-to-moderate eyelid sagging underwent a single HIFU session using a 2.0‑mm, 4‑MHz probe. Topical anesthetic cream was applied for 40 minutes before treatment. Standardized photographs were obtained at baseline and 12 weeks post-treatment. Two blinded clinicians evaluated outcomes using a 4‑point clinical grading scale. Patient satisfaction and changes in eyelid length were also assessed. Results: Seventeen of 20 patients (85%) demonstrated visible improvement at 12 weeks. Clinician assessment confirmed improvement in 15 patients (75%), and mean eyelid length was reduced compared to baseline. No severe adverse effects were reported. Conclusion: HIFU is a safe and effective non-invasive option for upper and lower eyelid sagging, providing measurable improvement with minimal downtime. Future controlled studies with larger cohorts are warranted to validate and expand these findings.